Provider Demographics
NPI:1356845333
Name:DOMINGUEZ, JAY VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:VINCENT
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:109 44TH AVE E STE 301
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3639
Mailing Address - Country:US
Mailing Address - Phone:941-242-9628
Mailing Address - Fax:941-242-9660
Practice Address - Street 1:109 44TH AVE E STE 301
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3639
Practice Address - Country:US
Practice Address - Phone:941-242-9628
Practice Address - Fax:941-242-9660
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL153675207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine